Moderated Poster

Poster, Podium & Video Sessions

MP63-11: Is it mandatory to perform urodynamics to identify occult stress urinary incontinence?

Sunday, May 14
3:30 PM - 5:30 PM
Location: BCEC: Room 153

Presentation Authors: Susane Hwang*, Luís Gustavo Toledo, Silvia Carramao, Armando Frade, Raquel Richetti, Sao Paulo, Brazil, Andre Matos, Salvador, Brazil, Antonio Auge, Sao Paulo, Brazil

Introduction: Occult stress urinary incontinece (OSUI) is defined as the stress incontinence only observed after the reduction of co-existent prolapse. The objective of this study was to investigate OSUI by physical examination and urodynamic study, comparing both methods.

Methods: This study enrolled 105 women with pelvic organ prolapse stage III and IV, according to the Pelvic Organ Prolapse Quantificaton (POP-Q) system, evaluated prospectively between January and December 2015. The study was reviewed and approved by the school´s Institutional Review Board and all included subjects signed informed consent before participating in the study. A standard history and physical examination was carried out and the investigaton of the OSUI was performed on supine standing and lithotomy position, reducing the prolapse using gauze and a Cheron dressing forceps. During physical examination, the patients were requested to cough and to do valsalva maneuver. Afterwords, they were asked to do the same maneuvers during multichannel urodynamics. Both evaluation were perfomed with 300ml bladder filling. The OSUI was defined when there was urine leakage only after the reduction of the prolapse.

Results: The mean patient age was 65.7 years, ranging from 40 to 89 years, mean parity 5.1 and mean body mass index 27.4. From a total of 105 patients, 70 (66.7%) presented with POP-Q stage III and 35 (33.3%) stage IV. Sixty three (60%) women were identified as occult stress incontinent, twenty seven (25.7%) as continent, and 15 (14.3%) as stress urinary incontinent (leaked without prolapse reduction). From the 63 OSUI subjects, 48 (76.2%) were identified in both evaluations, and 8 were identified only during physical examination, and 7 only during urodynamics. The sensitivity to detect OSUI during physical examination and urodynamics was 88.9% and 87.3% respectively (p=0.783). The value of Kappa to measure the agreement between both tests was 0.648 (95% CI, 0.441- 0.854). Anterior (p=0.006) and posterior (p<0.001) compartment stage IV prolapse showed increased risk of OSUI. Despite 86 (81.9%) patients mentioned storage symptoms, only 8 (7.6%) had urodynamic demonstrated detrusor overactivity.

Conclusions: Urodynamic study and physical examination are equivalent and concordant to demonstrate OSUI, thus it´s not mandatory to perform urodynamics to identify OSUI.

Source Of Funding: None

Susane M. Hwang

Santa Casa de Sao Paulo School of Medical Sciences

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